Any parent with a child suffering from severe asthma knows the gripping sense of panic, helplessness and fear that prompts a rush to the hospital emergency room during an attack.
Asthma is the third leading cause of hospitalizations for children, accounting for over 57,000 emergency department visits in New York State among people age 17 and younger, costing millions of dollars in potentially avoidable Medicaid costs.
Many of the triggers are environmental, such as smoke, allergens and pollutants. Where exposure is continuous, so too must be the interventions at the site of exposure — the home.
St. Mary’s Home Care has a multi-pronged approach involving a pediatric asthma home assessment program and a separate set of remote patient monitoring pilots that the organization has advanced with hospital partners under the Delivery System Reform Incentive Payment (DSRIP) program.
St. Mary’s assessment program targets patients with poorly controlled, persistent asthma who have had at least one emergency department visit or hospitalization and/or rescue inhaler medication. So far, 96 cases were identified for 234 assessments. Patients in the program had zero hospitalizations in the first year of implementation, with 88 percent of families able to demonstrate asthma skills taught by the St. Mary’s specialists and 85 percent having an asthma action plan that is vital to self-management, medication adherence, and identification of risks and symptoms.
In addition to nursing assessments, St. Mary’s is also using technologies like a smartphone-linked Bluetooth medication inhaler device which “senses” when medication has been dispensed. The information is monitored remotely, triaging an alert to St. Mary’s nurses to visit the home if necessary. To date, the program reports 100 percent medication adherence, and zero emergency department visits under a DSRIP collaboration with New York Presbyterian-Queens Hospital. A separate DSRIP pilot with Mount Sinai reports similar results also using remote-monitoring technologies.